Ethics and Law, Population, health and research

Question 1

What is meant by implied consent

Answer 1

Most patients expect that some information will be shared with those who are directly involved in their care. Unless the patient specifically objects

Question 2

When can information about a patient be shared without their consent [2]

Answer 2

if it is justified for the public interest (as detailed below)

or the patient lacks capacity

Question 3

When is disclosure of information required by law [4]

Answer 3

Following an order made by a judge or presiding officer of a court.
In certain cases of communicable disease, when you must inform the local authority.
To prevent an act of terrorism.
To comply with a statutory request made by a regulatory body such as the GMC.

Question 4

what injuries must be informed to the police at presentation

Answer 4

gunshot wounds and knife injuries (unless accidental or self harm)

given the risk to others

Question 5

can personal information of gunshot/knife patients be given to police

Answer 5

no

Question 6

What must a doctor do when something has gone wrong [4]

Answer 6

Tell the patient when something has gone wrong
Apologise to the patient (or carer or family member where appropriate)
Offer an appropriate resolution
Explain the potential short and long-term effects of the error

Question 7

saying sorry is an admission of legal liability

true or false?

Answer 7

false

Question 8

3 frameworks used when someone who lacks capacity refuses treatment

Answer 8

common law: used to treat patients in emergency scenarios
Mental Capacity Act: (MCA) used in patients who require treatment for physical disorders that affect brain function. Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia
Mental Health Act (MHA): used in patients who require treatment for mental disorders. For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3. A typical scenario would be a patient who has a mental health disorder attempting to discharge themselves, when it is thought this may result in harm

Question 9

deaths within how many hours of admission are referred to the coroner

Answer 9

24 hours

Question 10

which deaths are notifiable to the coroner

Answer 10

unexpected or sudden deaths
when the doctor attending the deceased did not see them within 28 days before death
this was increased from 14 days during the COVID pandemic
if a death occurs within 24 hours of hospital admission
accidents and injuries
suicide
industrial injury or disease (e.g. asbestosis)
deaths occurring as a result of ill treatment, starvation or neglect
the death occurred during an operation or before recovery from the effect of an anaesthetic
poisoning, including taking illicit drugs
stillbirths - if there is doubt as to whether the child was born alive
prisoner or people in police custody
service disability pensioners

Question 11

When is an advanced care directive not legally binding

Answer 11

if the patient is under 18
patient was not sound of mind

Question 12

what is an advanced directive

Answer 12

defined as a document written at a time when a person is of sound mind, of that individual’s preferences with respect to medical treatment, should they later become unable to express those wishes directly.

Question 13

When are advanced care directive not legally binding

Answer 13

The decision has been subsequently withdrawn
Power to make such decisions has been conferred to another person by creating a Lasting Power of Attorney
Since making the will the patient has acted in a way that is clearly inconsistent with the advance decision remaining their fixed decision
The person is not incapacitated and can decide for themselves
The treatment in question is not that specified in the advance decision
Any of the circumstances specified in the advance decision do not exist
There ‘are reasonable grounds for believing that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision at the time of the advance decision.’

Question 14

LPA or written advance decision: who has more precedence

Answer 14

LPA

Question 15

which offences do not have to be reported to the GMC

Answer 15

a) A fixed penalty notice for disorder unless it is specified in paragraph 4
b) payment of a fixed penalty notice for a road traffic offence,
c) Payment of a fixed penalty notice issued by local authorities (for example, for offences such as dog fouling or noise)’

Question 16

which offences MUST be reported to the GMC

Answer 16

Are found guilty of a criminal offence
Are charged with a criminal offence
Formally admit to committing a criminal offence (for example, by accepting a caution)
Accept the option of paying a penalty notice for an ASBO
Receive a cannabis warning
Have had your registration restricted, or have been found guilty of an offence, by another medical or other professional regulatory body.
Your conduct (including as part of a management team) has directly contributed to an organisation that has entered into a deferred prosecution agreement.

Question 17

Family can’t make decision for the patient if…

Answer 17

the patient has capacity

Question 18

cohort study: retrospective vs prospective

Answer 18

retrospective: Start with exposure at a point back in time and follow over time to check for a particular outcome (endpoint = now)

prospective: Start with exposure and follow over time to check for a particular outcome

Question 19

what is a case-control study

Answer 19

Start with outcome and look back to determine what factors made this more likely (demographic-matched control)

Question 20

definition of sensivity

Answer 20

correctly identify those with disease x (i.e. the substance is found in disease x every time)

example: dsDNA is only found in SLE, but isn’t in every SLE case = highly specific (96%), not very sensitive (60%)
So, if tested -ve, as the specificity is defined as “true negatives / total number without disease” (very high at
96% here) because the majority of people without dsDNA do not have SLE (as it is only found in SLE)

true positives / total number with the disease

Question 21

definition of specificity

Answer 21

correctly identify those without disease x (i.e. the substance is only found in disease x)

example: dsDNA is only found in SLE, but isn’t in every SLE case = highly specific (96%), not very sensitive (60%)
So, if tested -ve, as the specificity is defined as “true negatives / total number without disease” (very high at
96% here) because the majority of people without dsDNA do not have SLE (as it is only found in SLE)

true negatives / total number without the disease

Question 22

Positive Predictive Value

Answer 22

true positives / total number positive

Question 23

Negative Predictive Value

Answer 23

true negatives/ total number negatives

Question 24

following the application of a plaster cast, the majority of airlines restrict flying for __hours on flights of less than 2 hours or __ hours for longer flights

Answer 24

following the application of a plaster cast, the majority of airlines restrict flying for 24 hours on flights of less than 2 hours or 48 hours for longer flights

Question 25

Following an unsuccessful resuscitation attempt in hospital, an individual should be observed for signs of life for a minimum of ___________

Answer 25

Following an unsuccessful resuscitation attempt in hospital, an individual should be observed for signs of life for a minimum of 5 minutes

Question 26

what is selection bias

Answer 26

describing the non-random assignment of patients to a study group

Question 27

A ________ is primarily used to demonstrate the existence of publication bias in meta-analyses.

Answer 27

A funnel plot is primarily used to demonstrate the existence of publication bias in meta-analyses.

Question 28

the probability of detecting a statistically significant difference

Answer 28

power

Question 29

Deaths occurring within _______ of admission to hospital should be discussed with the coroner before a death certificate is issued

Answer 29

Deaths occurring within 24 hours of admission to hospital should be discussed with the coroner before a death certificate is issued

Question 30

parametric correlation test

Answer 30

Pearsons

Question 31

non parametric correlation test

Answer 31

Kendall, Spearman’s rank

Question 32

used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions

Answer 32

Chi squared

Question 33

compares two sets of observations on a single sample, e.g. a ‘before’ and ‘after’ test on the same population following an intervention

Answer 33

Wilcoxon signed-rank test

Question 34

compares ordinal, interval, or ratio scales of unpaired data

Answer 34

Mann-Whitney U test

Question 35

paired test vs unpaired test

Answer 35

data from same group vs unpaired data comes from two different groups of patients

Question 36

how is absolute risk reduction (ARR) calculated

Answer 36

risk in control group - risk in treatment group

Question 37

how is number needed to treat calculated

Answer 37

1 / ARR